Introduction
Perineal trauma is an extremely common and expected complication of vaginal birth. More than 85% of women having a vaginal birth suffer some degree of perineal trauma.1 Perineal tears occur with varying degrees. In first-degree tear, superficial injury to the vaginal mucosa that may involve the perineal skin, whereas in second-degree tear lacerations extend to the vaginal mucosa and perineal body. In severe perineal tears (third- and fourth-degree), the anal sphincter and rectal mucosa are torn, respectively.2-3Among different degrees of perineal tears, severe perineal tears are linked to the greatest morbidity, including pain, dyspareunia, faecal incontinence, urinary problems.1,4-5 For women who experience severe perineal trauma during childbirth, their physical and psychological outcomes can be complex, with some women experiencing social isolation and marginalization due to their ongoing symptomatology.6 Therefore, prevention of perineal trauma, and third- and fourth-degree lacerations in particular is essential.
Different techniques have been reported to prevent perineal lacerations, including warm compresses,7-8 perineal massage,7,9 hands-on technique,7,10Ritgen’s maneuver,7,11 and lubricant gel.12 Among these techniques, warm compresses and perineal massage showed a positive effect in reducing third-degree and fourth-degree perineal tears.7-9 Hands-on technique and Ritgen’s maneuver did not show any effect on severe perineal tears.7,10-11 The effects of the use of lubricant have been unclear and is still subject of debate.12Lubricants can effectively reduce the friction of the vaginal wall, may facilitate the delivery of the fetus and reduce perineal trauma. The aim of this systematic review and meta-analysis of randomized controlled trials (RCTs) was to evaluate whether or not the use of lubricants during vaginal delivery decreases perineal trauma, to inform the recommendations of Chinese guideline on clinical practice guides for prevention and management of perineal laceration in vaginal delivery.